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Additional file 1: Supplementary material.

Tittle: Efficacy and safety of mechanical circulatory support devices short-term ventricular assist device (VAD)/ventricular assist ECMO (VA-ECMO) in patients with acute cardiogenic shock and refractory cardiac arrest: A living overview. Authors: Karla Salas-Gama ORCID: https://orcid.org/0000-0003-4845-4899 Afilliation: Quality, Process and Innovation Direction, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Dimelza Osorio ORCID: https://orcid.org/0000-0001-6166-647X Afilliation: Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Aida Ribera ORCID: https://orcid.org/0000-0002-2604-6328 Afilliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Percy Efrain Pantoja ORCID: https://orcid.org/0000-0003-4095-8988 Afilliation: Quality, Process and Innovation Direction, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Mónica Ballesteros ORCID: https://orcid.org/0000-0001-5244-4795 Afilliation: Quality, Process and Innovation Direction, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Claudia Álvarez ORCID: https://orcid.org/0000-0002-9417-6845 Afilliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Aitor Uribarri ORCID: https://orcid.org/0000-0002-6911-7480 Afilliation: Cardiovascular Outcomes research and Epidemiology Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Ignacio Ferreira-González ORCID: https://orcid.org/0000-0002-1208-5561 Afilliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Soledad Romea ORCID: https://orcid.org/0000-0002-7832-369X Afilliation: Quality, Process and Innovation Direction, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Corresponding author: Aida Ribera Email address: aida.ribera@vhir.org Postal address: Cardiovascular Outcomes research and Epidemiology Unit, Vall d’Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Funding sources/sponsors: This work is part of a project that has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No MSCA-IF-EF-ST #894990 (to María Ximena Rojas). This work is also supported by the Hospital Universitario Vall d’Hebron. The funders and institutions did not take any part in the development of this study. Conflicts of interest: Authors have declared no conflict of interest. ABSTRACT: Objective This living overview aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of short-term mechanical circulatory support devices and ventricular assist device (VAD) /ventricular assist ECMO (VA-ECMO) in patients with acute cardiogenic shock and refractory cardiac arrest. Design Living overview of reviews. Database The Epistemonikos-L.OVE platform was used for evidence identification, screening, and selection. This platform has been validated as a repository for COVID-19, and proved to be a highly comprehensive source of evidence. The main search source for the L.OVE platform is the Epistemonikos database (https://www.epistemonikos.org), a comprehensive database that collates information from multiple sources to identify systematic reviews and their included primary studies,including Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, DARE, HTA Database, Campbell database, JBI Database of Systematic Reviews and Implementation Reports, EPPI-Centre Evidence Library. The team maintaining the Epistemonikos-L·OVE platform devised the literature search, using the following approach: i) Identification of terms relevant to the population and intervention components of the search strategy, using Word2vec technology to the corpus of documents available in Epistemonikos Database; ii) Discussion of search terms with methods experts to identify relevant, irrelevant and missing terms, iii) Creation of a sensitive boolean strategy encompassing all the relevant terms. The results of the literature searches were automatically incorporated into the L·OVE platform (automated retrieval) and organized in the corresponding L.OVE of “Mechanical assist devices for cardiovascular diseases”. Methods We conducted a rapid overview and generated a structured evidence summary with a pre-established format that includes key messages, a summary of the body of evidence (presented as an evidence matrix in Epistemonikos), a meta-analysis of all studies (when possible), a summary table of results with the method GRADE (Grades of Recommendation, Assessment, Development and Evaluation) and a section of other considerations for decision making. Results We identified four systematic reviews that together included five randomized trials comparing VAD (TandemHeart or Impella) with respect to the best treatment option (ionotropes and/or aortic balloon counterpulsation in patients with cardiogenic shock). There are no studies evaluating the efficacy of ECMO or studies evaluating the efficacy of VAD/ECMO in situations of cardiac arrest. Results on costs or on quality of life are not reported either. The evidence provided by systematic reviews identified do not show benefit of VAD (TandemHeart or Impella) on mortality at 30 days or at six months and, instead, a higher rate of bleeding is observed. Conclusions Up to date it is not clear whether or not the Impella and Tandem-Heart circulatory assist devices reduce overall mortality at 30 days or at six months of follow-up, because the uncertainty of the existing evidence, evaluated as very low according to GRADE approach. Impella and Tandem-Heart type circulatory assist devices might slightly increase the risk of bleeding (low certainty evidence). It is not possible to clearly establish whether Impella and Tandem-Heart type circulatory support devices increase the risk of lower limb ischemia, fever or sepsis, because the certainty of the existing evidence has been assessed as very low due to impresicion. © 2022 Hospital Universitario Vall d’Hebron, Spain/ EU H2020, Living Evidence to Inform Health Decisions Project. All rights reserved.

Acute cardiogenic shock (CS) is a state of inadequate organ perfusion due to failure of the heart pumping mechanism. CS is caused by severe impairment of myocardial performance that results in diminished cardiac output, end‐organ hypoperfusion, and hypoxia. Clinically this presents as hypotension refractory to volume resuscitation with features of end‐organ hypoperfusion requiring pharmacological or mechanical intervention. [1] It happens in about 3.5% of patients presenting with acute heart failure and 6.6% of patients presenting with myocardial infarction [2]. Despite advances in treatment mainly by early revascularization with subsequent mortality reduction, CS remains the leading cause of death in AMI with mortality rates still approaching 40–50% according to recent registries and randomized trials [3,4] Mechanical circulatory support (MCS) devices provide hemodynamic support and maintain vital organ perfusion thus providing therapeutic options for patients with CS when pharmacologic treatment is not sufficient or not suitable. While durable devices such as left ventricular assist devices (VAD) and total artificial heart are used selectively, percutaneous short-term devices, such as Impella and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are rapidly expanding and commonly used for short term mechanical support as a bridge to recovery, or as a bridge to cardiac transplant or to definitive VAD [1,5] Another potential use of the MCS is cardiac arrest (CA). CA is defined as the cessation of cardiac mechanical activity and circulation, which can be confirmed by the absence of a detectable pulse, unresponsiveness, and absence of a normal breathing pattern. It has been estimated that each year approximately 356,500 people suffer from out-of-hospital cardiac arrest (OHCA), and 209,000 from in-hospital cardiac arrest (IHCA) in the USA. [6]. ECMO is one of the mechanical devices that has been increasingly utilized for organ and circulatory support during refractory IHCA and OHCA. [7] MCS may ensure life-saving organ perfusion, lending clinicians crucial time to identify and treat the underlying cause of cardiac arrest. Knowledge of the best current evidence will guide patient management and service planning in the hospital setting.

Background: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. Methods: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. Results: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. Conclusions: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients.

Background: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. Methods: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach’s alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness./nResults: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. Conclusions: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients. This work was supported by grants from Instituto de Salud Carlos III FEDER(PS09/02139; PS09/01204; PS09/01619; PS09/02555; PI12/00772) and from AGAUR (2012FI_B1 00177; 2009 SGR 1095).

Objetivo: Describir las características epidemiológicas, clínicas y de tratamiento de los pacientes con tumores de tejidos blandos, melanoma y carcinomas escamocelulares del Servicio de Seno y Tejidos Blandos del instituto nacional de Cancerologìa con amputaciones mayores de extremidades entre los años 1998 y 2008. Métodos: Se revisaron 80 historias clínicas de pacientes adultos en quienes se realizó amputación mayor de una extremidad entre enero de 1998 y diciembre de 2008, en el Servicio de Seno y Tejidos Blandos del instituto nacional de Cancerología. Resultados: Se identificaron 24 pacientes con hemipelvectomía clásica, 22 con desarticulación de cadera, 19 con desarticulación interescapulotorácica, 8 con hemihemipelvectomía y 7 con desarticulación de hombro. los diagnósticos en orden de frecuencia fueron: sarcomas de tejidos blandos, 72,5%; carcinomas escamocelulares, 21,2%; melanoma, 6,2%. la intención de la cirugía fue curativa en 50% de los casos. En los pacientes en los cuales la intención de la cirugía fue paliativa, se presentó un mayor número de complicaciones, con significancia estadística solo para necrosis de los colgajos (22,5 vs. 5% p = 0,02). la supervivencia en los pacientes con intención curativa luego del primer año de cirugía fue de 67,5 vs. 42,5% para cirugía paliativa (p = 0,038). Conclusiones: En pacientes con tumores proximales de las extremidades con imposibilidad de cirugías preservadoras, las amputaciones mayores continúan siendo una opción terapéutica válida, a pesar de su alto índice de complicaciones. Objective: To describe the epidemiological, clinical and treatment characteristics of patients with soft tissue tumours, melanoma, and squamous cell carcinomas of the Breast and Soft Tissue Department of the Instituto Nacional de Cancerología, who had major limb amputations between the years 1998 and 2008. Methods: a review was made of the clinical records of 80 patients in whom a major limb amputation was performed between January 1998 and December 2008 in the Breast and Soft Tissue Department of the Instituto Nacional de Cancerología. Results: Of the 80 patients studied, 24 had a classic hemipelvectomy, 22 with hip disarticulation, 19 with interscapular-thoracic disarticulation, 8 with hemi-hemipelvectomy, and 7 with shoulder disarticulation. The diagnoses, in order of frequency were: soft tissue sarcomas, 72.5%; squamous cell carcinomas, 21.2%; and melanoma, 6.2%. The intention of the surgery was curative in 50% of the cases. There was a greater number of complications in the patients where the intention of the surgery was palliative, with a significant significance only for necrosis of flaps (22.5% vs. 5% p=.02). The one-year survival in the patients with intention to cure surgery was 67.5% vs. 42.5% for palliative surgery (p=.038). Conclusions: in patients with tumours proximal to the limbs, where preservative surgery is impossible, major amputations continue to be a valid therapeutic option, despite its high rate of complications.

Desfibrilador automático implantable; Muerte súbita cardíaca; Prevención primaria Implantable cardioverter defibrillator; Sudden cardiac death; Primary prevention Desfibril·lador automàtic implantable; Mort sobtada cardíaca; Prevenció primària Informe que té com a objectius analitzar nova evidència disponible i conèixer el valor actual del cost-utilitat del DAI, més el tractament mèdic convencional (TMC) enfront de TMC per a prevenció primària d’arrítmies cardíaques des de la perspectiva del Sistema Nacional de Salut (SNS). Report that report that aims to analyze new available evidence and to know the current value of the cost-utility of the Implantable Cardioverter Defibrillator (ICD) plus Conventional Medical Treatment (CCT) versus CCT for primary prevention of cardiac arrhythmias from the perspective of the Spanish National Health System (SNS). Informe que tiene como objetivo analizar nueva evidencia disponible y conocer el valor actual del coste-utilidad del Desfibrilador Automático Implantable (DAI) más Tratamiento Médico Convencional (TMC) frente a TMC para prevención primaria de arritmias cardiacas desde la perspectiva del Sistema Nacional de Salud (SNS).

Tittle: Effectiveness and safety of targeted/ biological therapy in patients with advanced ovarian cancer: A living systematic review. Authors: Laura Trujillo ORCID: [0000-0001-7345-604X] Affiliation: Programa Maestría en Investigación Clínica Aplicada a las Ciencias de la Salud. Facultad de Medicina de la Universidad Autónoma de Barcelona. Barcelona, España. Gerard Urrutia ORCID: [0000-0002-8850-0960] Affiliation: Centro Iberoamericano Cochrane, Instituto de Investigación Biomédica De Sant Pau (IIB Sant Pau), Barcelona, España. CIBER de Epidemiología Clínica y Salud Pública (CIBERESP), Barcelona, España. María Ximena Rojas ORCID: [0000-0001-5752-7653] Affiliation: Centro Iberoamericano Cochrane, Instituto de Investigación Biomédica De Sant Pau (IIB Sant Pau), Barcelona, España. Corresponding autor: Laura Trujillo Vargas E-mail address: trujillovargaslaura@gmail.com Postal address: Hospital de la Santa Creu i Sant Pau C/ Sant Antoni Maria Claret, 167. Pavellón 18, planta 0. 08025 Barcelona. España. Funding sources/sponsors: This work is part of a project that has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No MSCA-IF-EF-ST #894990 (to María Ximena Rojas). This work is also supported by the Hospital Universitario Vall d’Hebron. The funders and institutions did not take any part in the development of this study. Conflicts of interest: Authors have declared no conflict of interest. ABSTRACT: Objective This Living Systematic review aims to evaluate the efficacy and safety of targeted therapy (Bevacizumab, Olaparib, Niraparib, Rucaparib) for patients with advanced ovarian cancer. Design Living Systematic review. Database The Epistemonikos-L.OVE platform was used for evidence identification, screening, and selection. This platform has been validated as a repository for COVID-19, and proved to be a highly comprehensive source of evidence. The main search source for the L.OVE platform is the Epistemonikos database (https://www.epistemonikos.org), a comprehensive database that collates information from multiple sources to identify systematic reviews and their included primary studies, including Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, DARE, HTA Database, Campbell database, JBI Database of Systematic Reviews and Implementation Reports, EPPI-Centre Evidence Library. The team maintaining the Epistemonikos-L·OVE platform devised the literature search, using the following approach: i) Identification of terms relevant to the population and intervention components of the search strategy, using Word2vec technology to the corpus of documents available in Epistemonikos Database; ii) Discussion of search terms with methods experts to identify relevant, irrelevant and missing terms, iii) Creation of a sensitive boolean strategy encompassing all the relevant terms. The results of the literature searches were automatically incorporated into the L·OVE platform (automated retrieval) and organized in the corresponding L.OVE of “Targeted therapies for advanced ovarian cancer”. Methods We included only randomized controlled trials (RCT) evaluating the effect of targeted therapies — versus placebo or no treatment in patients with advanced ovarian cancer. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. Measures included overall survival, Progression-free survival, toxicity and health related quality of life. We applied the GRADE approach to assess the certainty of the evidence for each outcome. This is the second update report since our previous baseline evidence synthesis report for this question, completed in 04/03/2022 and the first update report completed in 01/06/2022. Results Since the beginning of this living review, searches have retrieved [400] references to the L·OVE platform. We considered [170] as potentially eligible and [131] were reviewed in full text. The baseline report had included [14] Systematic reviews and [6] randomized clinical trial that evaluated the use of targeted therapy compared to the use of placebo in patients with advanced ovarian cancer. Two [2] new systematic reviews, including one [1] new randomized clinical trial, had been included for the previous update (Living Overview). For this new update (Living systematic review), randomized clinical trials were considered, with seven [7] studies (RCTs) in total, including 25 references. For outcome Overall Survival, analysis showed a favorable effect of targeted therapy use between groups for the BRCA population (HR 0.69; 95% CI [0.54 to 0.88]) and Progression-Free Survival outcome, the analysis showed a favorable effect of targeted therapy use between groups for the mixed population (HR 0.47; 95% CI [0.40 to 0.55]), BRCA mutated population (HR 0.29; 95% CI [0.25 to 0.33]), and without BRCA mutation (HR 0.39; 95% CI [0.33 to 0.46]). The GRADE quality of the evidence for the main outcomes was high. Conclusions The use of targeted therapy has a clear favorable effect compared to placebo on outcomes such as overall survival and progression-free survival in advanced ovarian cancer in the entire population, but more clearly in the BRCA-mutated population. Although it is true that a favorable effect on health-related quality of life was reported, they do not have a clinically relevant magnitude; and also no study reported on the outcome of disease-related symptoms. The new emerging evidence detected through the updates (RCT), it was concluded that it would be advisable to continue with the monitoring and ideally make a de novo systematic review which is what has been done in this update. © 2022 Hospital de la Santa Creu i Sant Pau, Spain/ EU H2020, Living Evidence to Inform Health Decisions Project. All rights reserved.

Tittle: Effectiveness and safety of Fecal Microbiota Transplant in the Treatment of ulcerative colitis: A living systematic review. Authors: Andrea Correa-Pérez Afilliation: Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain. Faculty of Medicine. Universidad Francisco de Vitoria, Madrid, Spain Jorge de Vicente Guijarro Afilliation: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal (IRYCIS) Madrid, Spain Andrea Gaetano Gil Afilliation: Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain Juan Ocaña Jiménez Afilliation: Servicio de Cirugía General y del Aparato Digestivo. Unidad de Coloproctología. Hospital Universitario Ramón y Cajal, Madrid, Spain Raquel Luengo González Afilliation: Department of Nursing and Physiotherapy. University of Alcalá, Madrid, Spain David Rigau Comas Afilliation: Iberoamerican Cochrane Centre. C/ Sant Antoni Maria Claret, 167. Pavelló 18, planta 0, 08025 Barcelona, Spain. CIBER de Epidemiología Clínica y Salud Pública (CIBERESP). Josefina Bendersky Afilliation: Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Hospital de la Santa Creu i Sant Pau. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain María Ximena Rojas Reyes Afilliation: Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Hospital de la Santa Creu i Sant Pau. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain María N Plana Farrás Afilliation: Unidad de Evaluación de Tecnologías Sanitarias, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain. CIBER Epidemiology and Public Health (CIBERESP) Corresponding author: Maria N Plana Farrás. Email address: nieves.plana@salud.madrid.org Postal address: Unidad de Evaluación de Tecnologías Sanitarias, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España. CIBER de Epidemiología y Salud Pública (CIBERESP). Funding sources/sponsors: This work is part of a project that has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No MSCA-IF-EF-ST #894990 (to María Ximena Rojas). This work is also supported by the Health Tecnology Assesment Unit of the Hospital Universitario Ramón y Cajal. The funders and institutions did not take any part in the development of this study. Conflicts of interest: Authors have declared no conflict of interest. ABSTRACT: Objective This living systematic review aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of fecal microbiota transplant (FMT) for treatment of patients with moderate to severe ulcerative colitis (UC). Design Living systematic review. Database The Epistemonikos-L.OVE platform was used for evidence identification, screening, and selection. This platform has been validated as a repository for COVID-19, and proved to be a highly comprehensive source of evidence. The main search source for the L.OVE platform is the Epistemonikos database (https://www.epistemonikos.org), a comprehensive database that collates information from multiple sources to identify systematic reviews and their included primary studies, including Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, DARE, HTA Database, Campbell database, JBI Database of Systematic Reviews and Implementation Reports, EPPI-Centre Evidence Library. The team maintaining the Epistemonikos-L·OVE platform devised the literature search, using the following approach: i) Identification of terms relevant to the population and intervention components of the search strategy, using Word2vec technology to the corpus of documents available in Epistemonikos Database; ii) Discussion of search terms with methods experts to identify relevant, irrelevant and missing terms, iii) Creation of a sensitive boolean strategy encompassing all the relevant terms. The results of the literature searches were automatically incorporated into the L·OVE platform (automated retrieval) and organized in the corresponding L.OVE of “Fecal microbiota transplant for ulcerative colitis”. Methods To prioritize the fecal microbiota transplantation administration route, comparators and outcomes more relevant for supporting the clinical decisions in the treatment of ulcerative colitis patients, we performed a Delphi process conducted by an expert panel in the field of gastroenterology and colorectal surgery. Given Delphi panel results, we decided to include randomized studies evaluating the efficacy and safety of FMT versus any active treatment in patients with moderate to severe ulcerative colitis. Measures included clinical remission, clinical relapse, endoscopic release, clinical response, free time without corticosteroid treatment, serious adverse events and health related quality of life. Two reviewers independently screened each study for eligibility. We planned to extract data and assess the risk of bias using the ROB-2 tool by duplicate. We also planned to apply the GRADE approach to assess the certainty of the evidence for each outcome. This is the first update report since our previous baseline evidence synthesis report for this question. Last search date 11/07/2022. Results Since the beginning of this living review, searches have retrieved 202 references to the L·OVE platform. 28 were considered potentially eligible and 16 were reviewed in full text. The initial baseline report did not include any randomized clinical trial that evaluated the use of FMT compared to the use of any active treatment in patients with moderate to severe ulcerative colitis. No new randomized clinical trials were included for this update. Conclusions No randomized trials evaluating the effect of FMT versus any active treatment in patients with moderate to severe ulcerative colitis have been identified. As of this update, this Living Systematic Review will be withdrawn from the living model, as research on the review (PICO) question is not emerging. © 2022 Hospital Universitario Ramón y Cajal, Spain/ EU H2020, Living Evidence to Inform Health Decisions Project. All rights reserved.

Tittle: Effectiveness and safety of Fecal Microbiota Transplant in the Treatment of ulcerative colitis: A living overview. Authors: Andrea Correa-Pérez Afilliation: Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain. Faculty of Medicine. Universidad Francisco de Vitoria, Madrid, Spain Jorge de Vicente Guijarro Afilliation: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal (IRYCIS) Madrid, Spain Andrea Gaetano Gil Afilliation: Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain Juan Ocaña Jiménez Afilliation: Servicio de Cirugía General y del Aparato Digestivo. Unidad de Coloproctología. Hospital Universitario Ramón y Cajal, Madrid, Spain Raquel Luengo González Afilliation: Department of Nursing and Physiotherapy. University of Alcalá, Madrid, Spain David Rigau Comas Afilliation: Iberoamerican Cochrane Centre. C/ Sant Antoni Maria Claret, 167. Pavelló 18, planta 0, 08025 Barcelona, Spain. CIBER de Epidemiología Clínica y Salud Pública (CIBERESP). Josefina Bendersky Afilliation: Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Hospital de la Santa Creu i Sant Pau. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain María Ximena Rojas Reyes Afilliation: Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Hospital de la Santa Creu i Sant Pau. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain María N Plana Farrás ORCID: 0000-0003-0921-7954 Afilliation: Unidad de Evaluación de Tecnologías Sanitarias, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain. CIBER Epidemiology and Public Health (CIBERESP) Corresponding author: Maria N Plana Farrás. Email address: nieves.plana@salud.madrid.org Postal address: Unidad de Evaluación de Tecnologías Sanitarias, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España. CIBER de Epidemiología y Salud Pública (CIBERESP). Funding sources/sponsors: This work is part of a project that has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No MSCA-IF-EF-ST #894990 (to María Ximena Rojas). This work is also supported by the Health Tecnology Assesment Unit of the Hospital Universitario Ramón y Cajal. The funders and institutions did not take any part in the development of this study. Conflicts of interest: Authors have declared no conflict of interest. ABSTRACT: Objective This living overview bring together all the evidence from systematic reviews assessing the effectiveness and safety of fecal microbiota transplantation (FMT) in patients with ulcerative colitis (UC). Particularly, in patients with moderate to severe UC refractary to corticosteroids treatment. Is in these patients where TMF has been proposed as a therapeutic alternative to improve the inflammation control. Design Living overview of reviews. Database The Epistemonikos-L.OVE platform was used for evidence identification, screening, and selection. This platform has been validated as a repository for COVID-19, and proved to be a highly comprehensive source of evidence. The main search source for the L.OVE platform is the Epistemonikos database (https://www.epistemonikos.org), a comprehensive database that collates information from multiple sources to identify systematic reviews and their included primary studies, including Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, DARE, HTA Database, Campbell database, JBI Database of Systematic Reviews and Implementation Reports, EPPI-Centre Evidence Library. The team maintaining the Epistemonikos-L·OVE platform devised the literature search, using the following approach: i) Identification of terms relevant to the population and intervention components of the search strategy, using Word2vec technology to the corpus of documents available in Epistemonikos Database; ii) Discussion of search terms with methods experts to identify relevant, irrelevant and missing terms, iii) Creation of a sensitive boolean strategy encompassing all the relevant terms. The results of the literature searches were automatically incorporated into the L·OVE platform (automated retrieval) and organized in the corresponding L.OVE of “Fecal microbiota transplant for ulcerative colitis”. Methods We conducted a rapid overview and generated an structured evidence summary following a pre-established format that includes key messages, a summary of the body of evidence (presented as an evidence matrix in Epistemonikos), a meta-analysis of all studies (when possible), a summary table of results with the method GRADE (Grades of Recommendation, Assessment, Development and Evaluation) and a section of other considerations for decision making. Results We identified 16 systematic reviews that together included 79 primary studies, five of which were randomized clinical trials comparing FMT with placebo thefore were considered for analysis. Fecal microbiota transplant compared to placebo in patients with moderate to severe UC could increase the proportion of patients with clinical remission (RR 1.80, 95% CI (1.24 to 2.61)) and clinical remission with endoscopic response/remission ( RR 2.89, 95% CI (1.63 to 5.14)). There is uncertainty about the risk of serious adverse events associated with fecal microbiota transplant (RR 1.40, 95% CI (0.55 to 3.58)) very low certainty of the evidence due to inconsistency and impresicion. Conclusions This summary results are partially consistent with the identified systematic reviews . Fecal microbiota transplant showed to increase the proportion of patients with clinical remission and/or endoscopic response. There is uncertainty about the risk of serious adverse events related to the intervention. The certainty of the evidence is low or very low. © 2022 Hospital Universitario Ramón y Cajal, Spain/ EU H2020, Living Evidence to Inform Health Decisions Project. All rights reserved.